On The Quick

Nurse Practitioners Fight Opioid Abuse

SB 554 clears NPs to prescribe buprenorphine

Last year, a new federal law sought to enlist nurse practitioners in the battle against opioid abuse. Now, California has passed a law to ensure that qualified nurse practitioners in our state can prescribe buprenorphine for opioid addiction.

New Laws

Under federal law, prescribing narcotic drugs to treat addiction requires a Controlled Substances Act waiver from the U.S. Department of Health and Human Services (HHS). Previously, only physicians could apply for the waivers, but the Comprehensive Addiction and Recovery Act of 2016 (CARA) allows nurse practitioners and physician assistants to do so as well.

However, CARA still allows states to impose more stringent restrictions, such as additional education requirements or even rules limiting dispensing to certain practice settings. Those state rules can make it tough for nurse practitioners to prescribe important treatment drugs even if the NP meets federal requirements.

Here in California

Luckily, that won’t be a problem in California thanks to the recent enactment of S.B. 554. This bill, introduced in February by State Sen. Jeff Stone (R-Temecula) and signed by Gov. Brown on September 11, updates state law.

California nurse practitioners who meet federal CARA requirements can prescribe the drug buprenorphine for opioid addiction — without having to jump through additional legal hoops.

California Association of Nurse Practitioners President Theresa Ullrich, FNP-C, MSN, applauds the passage of S.B. 554, saying NPs want “to be part of the solution and be able to help these patients working with other healthcare professionals.”

CARA Requirements

Buprenorphine is a schedule III opioid drug widely used in medication-assisted treatment for opioid addiction. Like methadone, buprenorphine helps to mitigate a patient’s cravings and withdrawal symptoms while limiting the risk of further abuse or overdose.

To apply for an HHS waiver to prescribe buprenorphine, a nurse practitioner must first have at least 24 hours of appropriate training. The applicant must also be able to provide patients with all FDA-approved opioid treatment drugs, either directly or by referral.

A first-time waiver recipient may treat no more than 30 opioid-addicted patients at a time. Providers who’ve had a waiver for at least a year can apply for special permission to treat up to 275 patients at a time.

Neither CARA nor the new state law waives the physician supervision requirements for California NPs.